Relationship between serum cholesterol and Grav... - Thyroid UK

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Relationship between serum cholesterol and Graves' orbitopathy (GO): a confirmatory study

helvella profile image

The abstract of this paper is like many others in that it switches between "high cholesterol" and "low-density lipoprotein (LDL)-cholesterol". Well, perhaps it all makes more sense in the full paper? (Though that is behind a paywall.) Still, the simple observation of an association is interesting and might help to pave the way to some understanding of the disease processes.

J Endocrinol Invest. 2018 Jun 19. doi: 10.1007/s40618-018-0915-z. [Epub ahead of print]

Relationship between serum cholesterol and Graves' orbitopathy (GO): a confirmatory study.

Lanzolla G1, Sabini E1,2, Profilo MA1, Mazzi B1, Sframeli A3, Rocchi R1, Menconi F1, Leo M1, Nardi M3, Vitti P1, Marcocci C1, Marinò M4.

Author information

1 Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.

2 Division of Immunology, Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, MD, USA.

3 Ophthalmopathy Unit I, Department of Surgical, Medical and Molecular Pathology, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.

4 Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.



It has been suggested that high cholesterol represents a risk factor for Graves' orbitopathy (GO). In a recent cross-sectional study, a correlation between cholesterol and the presence of GO was found in patients with a Graves' disease (GD) of recent onset. To confirm this observation, we conducted a retrospective investigation in consecutive patients with GD. The primary outcome was the relationship between the presence of GO and low-density lipoprotein (LDL)-cholesterol.


The design entailed the inclusion of consecutive patients with a GD of recent onset, with or without GO, who came to our observation to receive radioiodine over a period of 6 months, and a stratification aimed at having two homogeneous group of patients in terms of thyroid function. A total of 86 patients fulfilled the inclusion and evaded the exclusion criteria. All patients underwent an ophthalmological assessment and serum lipids were measured.


Serum levels of LDL-cholesterol were significantly higher in patients with GO (135.3 ± 41.3 mg/dL) compared with those without GO (106.6 ± 23.9 mg/dL, P = 0.0007). In a similar manner, serum levels of total cholesterol were higher in patients with GO (211.6 ± 44.0 mg/dL) than in those without GO (176.0 ± 27.2 mg/dL, P = 0.0001). There was no relationship between GO severity and activity and cholesterol. There was no relationship between GO and high-density lipoprotein-cholesterol or triglycerides.


Our study confirms a relationship between the presence of GO and cholesterol in patients with GD of recent onset. Whether lowering of cholesterol ameliorates, GO remains to be established.


Cholesterol; Graves; Ophthalmopathy; Orbitopathy; Statins

PMID: 29923059

DOI: 10.1007/s40618-018-0915-z

5 Replies

Thanks for this helvella. I’m a bit confused as high cholesterol is often associated with hypothyroidism(low thyroid) and Graves, before treatment, usually means hyperthyroidism (high thyroid) The patients that got through the exclusion criteria all seem to have quite high cholesterol levels to me.

LDL with GO of 135.3 +/- 41.3 in mg/dl is 7.51 +/- 2.29 mmol/l

LDL without GO 106.6 +/- 23.9 in mg/dl is 5.92 +/- 1.32 mmol/l

The non LDL parts such as HDL and tryglycerides were not significant though of course the Total cholesterol is likely to be because of the high LDL component. The LDL calculation may not be valid at these high levels!

My Total cholesterol under Simvastatin (10 mg) is 3.6 mmol/l, about half the LDL level in the GO group in this study.....

helvella profile image
helvellaAdministrator in reply to Bob00752

I too was somewhat confused! And surprised.

I rather assumed they were all genuinely hyper - but who knows as they were headed for radio-active iodine treatment. Perhaps they were on sufficient anti-thyroid medicine to make them hypothyroid? Or is it more complicated than it would appear?

I am always amazed at the amount of research you do, Helvella. I find that one of the problems with these studies is that they raise more questions than they answer. For a start, what is ‘high’ cholesterol; who determined what was deemed ‘high’ or ‘low’ and why? I wonder if there will be further studies to see if lowering cholesterol, to whatever level, will resolve the Graves. I always thought that higher cholesterol was protective.

I have just found a short report of a study, admittedly reported in the Daily Mail, printed in May last year where a study found the T4 had no effect whatsoever and should not be prescribed. (That sound you can hear is my banging my head against the wall.). The ‘expert’ leading the study suggests that T4 is a waste of money as there was no difference in alleviation of symptoms with T4 or a placebo. NOWHERE is there a mention that the problem may have been that the cohort in the study needed T3 as well as T4 to alleviate their symptoms. I’m not sure why I bother to read these things as it only gets me mad.

Thank you for all your work.

Bob00752 profile image
Bob00752 in reply to penny

Thanks Penny and hellvella. One thought is that they have found a correlation between cholesterol levels and Graves GO - it doesn’t mean (yet) that there is a cause an effect between one and the other. There coukd be something else that causes both to be raised in risk (more likely). Presumably that could be the subject of further research.

I would also be interested in the cholesterol levels of those that they rejected in the study as not meeting their filtering requirements. That might give clues as to whether the reject’s cholesterol was in the same range as those in the study as to my mind they (the study cohort) are higher than the population’s cholesterol.

Of course I might be reading too much into some brief summary figures.

Hi Helvella, hoping you can help on a completely different matter to your post (sorry the message button is not working for some reason). Gp wants to see me after blood tests. Think shes freaked out beacuse TSH: <0.05 (0.50-4.4), FT4 11.5 (10-20) and FT3 4.5 (3.5-6.5). She prescribed me nature throid but i think she will want to drop the dose due to suppressed tsh and low ft4. Do you have any articles etc (a gp would like) saying this is fine when on NDT? I already have Toft's one. Thanks!

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